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Pec11 chap 35 abdominal trauma
1.
Prehospital: Emergency Care Eleventh
Edition Chapter 35 Abdominal and Genitourinary Trauma Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
2.
Learning Readiness Copyright ©
2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • EMS Education Standards, text p. 1041. • Chapter Objectives, text p. 1041. • Key Terms, text p. 1041. • Purpose of lecture presentation versus textbook reading assignments.
3.
Setting the Stage Copyright
© 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Overview of Lesson Topics – The Abdomen – Genital Trauma
4.
Case Study Introduction Copyright
© 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved Vanessa Judy, a 35-year-old woman, is the driver of a vehicle hit on the driver’s side door. There is about 12 inches of intrusion into the driver’s compartment at the site of impact. She is awake and alert, complaining of left shoulder pain. Her skin is warm and dry. The EMTs’ examination reveals tenderness to palpation of the left upper quadrant, along with bruising of the left lower ribs.
5.
Case Study Copyright ©
2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • What organ do you suspect may have been injured with this mechanism of injury? • What are the consequences of injury to this organ? • What are the treatment and transport considerations for this patient?
6.
Introduction Copyright © 2018,
2014, 2010 Pearson Education, Inc. All Rights Reserved • Abdominal trauma has the potential to cause severe bleeding and hemorrhagic shock. • It is important to recognize mechanisms of injury and signs and symptoms of abdominal trauma. • Trauma to the external genitalia also can produce severe blood loss.
7.
The Abdomen (1
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Anatomy of the Abdominal Cavity – The abdominal cavity is bounded by the diaphragm, abdominal and back muscles, the spine, and pelvis. – The abdomen contains organs of the digestive, urinary, and endocrine systems. – The visceral peritoneum supports the organs. The parietal peritoneum adheres to the walls of the abdominal cavity.
8.
The Abdomen (2
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Anatomy of the Abdominal Cavity – Space between the visceral and parietal peritonea is called the peritoneal space. – The peritoneal lining has sensitive nerves that produce severe, constant pain when irritated by substances leaking into the abdominal cavity.
9.
The Abdomen (3
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Anatomy of the Abdominal Cavity – Types of Abdominal Organs and Structures ▪ Hollow abdominal organs are not as vascular, but if their contents are leaked into the abdominal cavity, peritonitis results. ▪ Peritonitis can be life-threatening, but signs and symptoms may be delayed by hours.
10.
The Abdomen (4
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Anatomy of the Abdominal Cavity – Types of Abdominal Organs and Structures ▪ Solid organs are vascular and can bleed profusely when injured. ▪ Bleeding may not produce severe abdominal pain. ▪ Be alert to signs of shock.
11.
The Abdomen (5
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Anatomy of the Abdominal Cavity – Types of Abdominal Organs and Structures ▪ Vascular Structures – Abdominal aorta – Inferior vena cava – Supplies blood to abdominal organs
12.
The Abdomen (6
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Anatomy of the Abdominal Cavity – Additional Structures ▪ Diaphragm – Muscle of respiration that separates the thoracic and abdominal cavities. – If injured by penetrating or blunt trauma, breathing can be impaired and abdominal organs can enter the thoracic cavity. – It can be injured from a penetrating injury or from severe blunt force.
13.
The Abdomen (7
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Anatomy of the Abdominal Cavity – Additional Structures ▪ Abdominal Wall – An open wound in the abdominal wall can allow evisceration of the abdominal contents. – Protect the exposed organs from further injury or contamination. – Do not attempt to replace the organs.
14.
Click on the
Problem of Most Immediate Concern for a Patient with Abdominal Injury Who has a Ruptured Diaphragm Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved a. Impaired respiration b. Hemorrhage c. Abdominal distention d. Peritonitis
15.
The Abdomen (8
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Abdominal Injuries – Mechanisms of injury can be blunt or penetrating. – Injuries may be open or closed. – Open wounds to the abdomen are much more dramatic and easier to find upon assessment than closed wounds.
16.
The Abdomen (9
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Scene Size-Up ▪ Ensure scene safety. ▪ Assess the mechanism of injury; determine the characteristics of weapons. ▪ With penetrating trauma, anticipate multiple wounds. ▪ Blunt trauma may be more subtle.
17.
Abdominal Injury from
a Knife Wound (© Edward T. Dickinson, MD) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
18.
The Abdomen (10
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Primary Assessment ▪ In the general impression, note the patient’s position. ▪ Patients with abdominal injuries may have their legs drawn up.
19.
Patients with Abdominal
Injuries Often Lie with Legs Drawn up in the Fetal Position Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
20.
The Abdomen (11
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Primary Assessment ▪ If spinal injury is suspected, use in-line stabilization. ▪ Establish and maintain a patent airway; suction as needed. ▪ Maintain an SpO2 greater than or equal to 94% and use positive pressure ventilation if breathing is inadequate.
21.
The Abdomen (12
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Secondary Assessment ▪ Consider the patient’s complaints and mechanism of injury. ▪ Perform a rapid secondary assessment. ▪ Provide spine motion restriction if spinal injury is suspected.
22.
The Abdomen (13
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Secondary Assessment ▪ Inspect the abdomen. – Look for contusions, lacerations, abrasions, and punctures. – Look for distention. – Look for discoloration around the umbilicus and flanks.
23.
The Abdomen (14
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Secondary Assessment ▪ Palpate the abdomen. – Start at the point farthest away from the point of pain. – Note any masses or tenderness. – Note any rigidity.
24.
The Abdomen (15
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Secondary Assessment ▪ Assess the extremities, including pulses and sensory and motor function. ▪ Inspect the posterior body. ▪ Obtain baseline vital signs.
25.
The Abdomen (16
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Secondary Assessment ▪ Assess vital signs. ▪ Obtain a history. ▪ OPQRST can be used to assess symptoms. ▪ Signs and symptoms.
26.
The Abdomen (17
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – General Emergency Medical Care — Abdominal Trauma ▪ Establish and maintain an open airway. – Maintain spine motion restriction and adequate oxygenation. – Reassess breathing; provide positive pressure ventilation for inadequate breathing.
27.
The Abdomen (18
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – General Emergency Medical Care — Abdominal Trauma ▪ Treat for hemorrhagic shock. ▪ Control external bleeding; treat evisceration. ▪ Position the patient with legs flexed, if possible.
28.
The Abdomen (19
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – General Emergency Medical Care — Abdominal Trauma ▪ Stabilize an impaled object. ▪ Transport as quickly as possible.
29.
The Abdomen (20
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – General Emergency Medical Care — Abdominal Evisceration ▪ Do not touch or attempt to replace the organs. ▪ If you note deterioration, reevaluate the priority status of the patient and expedite transport.
30.
EMT Skills 35-1 Copyright
© 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved Dressing an Abdominal Evisceration
31.
Cut Away Clothing
from the Wound and Support the Knees in a Flexed Position Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
32.
Place a Premoistened
Dressing over the Wound (Follow Local Protocol) and Gently Tape it in Place Do not attempt to replace intestines within the abdomen. Place a premoistened dressing over the wound. Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
33.
Apply an Occlusive
Covering (Follow Local Protocol). Tape it Loosely to Keep the Dressing Moist Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved
34.
The Abdomen (21
of 21) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Assessment-Based Approach: Abdominal Trauma – Reassessment ▪ Repeat the primary and secondary assessments. ▪ Repeat vital signs. ▪ Observe for indications of deterioration. ▪ Check the effectiveness of interventions.
35.
Genital Trauma (1
of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • While injuries to the genitalia are rarely life threatening, they are typically extremely painful and can be quite embarrassing for the patient.
36.
Genital Trauma (2
of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Injuries to the Male Genitalia – Control bleeding with direct pressure. – Apply cold if the scrotum is injured. – If the penis is avulsed or amputated, wrap the part in a sterile, saline-moistened dressing and keep it cool. – Assess for and manage shock.
37.
Genital Trauma (3
of 3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Injuries to the Female Genitalia – Control external bleeding with direct pressure. – Do not pack or place dressings in the vagina. – Assess for and manage shock.
38.
Case Study Conclusion Copyright
© 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved The EMTs recognize the potential for injury to the spleen and the associated risk of bleeding. They provide spine motion restriction and begin transport, obtaining a baseline set of vital signs and carefully monitor the patient for signs of shock. An abdominal ultrasound in the emergency department reveals blood in the capsule around the spleen, and the patient undergoes a splenectomy.
39.
Lesson Summary (1
of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Abdominal injuries may present subtly, but can result in peritonitis and life-threatening hemorrhage. • Eviscerations are treated with a moist, sterile dressing covered by an occlusive dressing. • The patient with abdominal injuries may be most comfortable with the legs drawn up.
40.
Lesson Summary (2
of 2) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved • Genital trauma can be painful and bleed profusely. • Manage external genital bleeding with direct pressure.
41.
Correct! Copyright © 2018,
2014, 2010 Pearson Education, Inc. All Rights Reserved The diaphragm is the primary muscle of respiration. If it is torn or ruptured, it interferes with generating the negative intrathoracic pressure needed for ventilation. Abdominal organs may migrate through the opening, further impairing ventilation. Click here to return to the Program.
42.
Incorrect (1 of
3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved Significant hemorrhage is primarily a concern with damage to solid organs, such as the liver, spleen, and kidney. Click here to return to the quiz.
43.
Incorrect (2 of
3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved Abdominal distention occurs in trauma when there is significant accumulation of blood in the abdominal cavity. Click here to return to the quiz.
44.
Incorrect (3 of
3) Copyright © 2018, 2014, 2010 Pearson Education, Inc. All Rights Reserved Peritonitis, inflammation of the peritoneum, occurs early with perforation of hollow organs, and later with bleeding into the abdominal cavity. Click here to return to the quiz.
45.
Copyright Copyright © 2018,
2014, 2010 Pearson Education, Inc. All Rights Reserved
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